Coding and Billing Core Competencies
The role of a Certified Professional Coder or Certified Biller is to bill medical healthcare
charges within Federal and State guidelines, and through the proper use of Current Procedure
Terminology, Diagnoses Codes and Health Care Procedure Coding.
Mastery of the following key competencies is required:
1. Professionalism
Competency Builders
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Prepare for successful completion of national certification for billing and/or coding
Follow all Standards of Ethical coding
Follow Federal, State and local protocols, procedures, and billing guidelines
Utilize and navigate through a billing program
Produce accurate and timely billing and coding results based on employer standards
Stay current with job-related changes, technology including EMR, E-Script and ICD10 codes, and certifications
Execute responsibilities with confidence, integrity and honesty
 Work with minimal supervision
 Maintain attitude as a “co-owner”
Maintain a professional, clean and conservative appearance
2. Customer Service
Competency Builders
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Communicate clearly with all customers
 Tailor all communications and level of information provided based on personality
styles and type of customer (patients, physicians, insurance carriers, staff,
laboratories, radiology, etc.)
 Ask appropriate questions based on type of customer
 Answer questions with accuracy, honesty and diligence, and acknowledge when
you need to seek additional information
Utilize communication skills to adapt your message and maximize effectiveness of
interactions
 Adjust communications based on individual’s body language, tone, and
expression
 Maintain eye contact and utilize effective listening skills
 Exhibit sensitivity to customer situation
Maintain reimbursement and revenue for physician or facility
3. Patient Advocacy
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Take necessary steps to resolve customer issues and produce a positive outcome
 Research and gather all pertinent information
 Build a network of resources to enhance contact base and increase knowledge
in order to provide better patient administrative outcomes
Maintain and manage patient data and insurance information, following all
protocols related to customer privacy
Educate office staff on information required to submit timely and accurate bills on
the patients’ behalf
4. Legal and Ethical Standards
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Recognize unethical and/or fraudulent billing and medical care situations and
follow appropriate protocols to report and/or resolve
Adhere to all Federal and State regulations and guidelines related to HIPPA, OIG,
compliance, and medical coding and billing behaviors and practices
Adhere to Red Flag laws on proper identification of patient
Educate and advise physicians, midlevel providers and NPP of new and upcoming
Federal, State, and Insurance carrier guidelines, and on ethical standards
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